Provider Demographics
NPI:1740997840
Name:LILYCARE OF NEW MEXICO LLC
Entity type:Organization
Organization Name:LILYCARE OF NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:STAWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-424-8737
Mailing Address - Street 1:4811 HARDWARE DR NE STE C-1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2021
Mailing Address - Country:US
Mailing Address - Phone:505-933-3773
Mailing Address - Fax:505-544-1335
Practice Address - Street 1:4811 HARDWARE DR. NE STE C-1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2023
Practice Address - Country:US
Practice Address - Phone:505-808-3202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based